38 Questions
What is the minimum duration of combined estrogen/progestogen therapy that increases the risk of breast cancer?
Three to five years
Why is progestogen prescribed in addition to estrogen in women with a uterus?
To reduce the risk of endometrial cancer
What is the most effective treatment for hot flashes according to the passage?
Estrogen
What is the recommended prescription practice for hormone therapy in women with a uterus?
Prescribe combination therapy only for menopausal symptoms, using the smallest effective dosage for the shortest possible duration
What alternative therapy has been shown to have a modest improvement in hot flashes and vaginal dryness?
Soy products
What is the benefit of using a combined formulation of estrogen and bazedoxifene?
Tolerance of adverse effects of progestogens
What therapy has been shown to significantly reduce hot flashes according to small studies?
Clinical hypnosis
What is the consensus on the effectiveness of alternative therapies such as yoga, paced respiration, and acupuncture in treating menopausal symptoms?
They have no significant benefit beyond placebo
What is the primary concern when using progestogens in patients?
All of the above
Which of the following is a contraindication for Duavee?
All of the above
What is the benefit of using bazedoxifene in combination with estrogen?
It does not stimulate the endometrium
What is the purpose of titrating clonidine dosage from a lower level?
To minimize the risk of dizziness
What is the current status of stellate ganglion block for menopausal symptoms?
It has shown promise in uncontrolled studies and one small randomized trial
What is the potential limitation of using clonidine for menopausal symptoms?
It causes hypotension and dizziness
What percentage of women are affected by genitourinary syndrome of menopause?
Up to one-half
What is the recommended age for discontinuing oral contraceptives when transitioning to hormone therapy?
Mid-50s
What is the main reason for measuring follicle-stimulating hormone levels after stopping oral contraceptives?
To determine if it is safe to transition to hormone therapy
What is the most common adverse effect of ospemifene?
Hot flashes
What is the recommended treatment for women with genitourinary syndrome of menopause who do not respond to nonhormonal medications?
Low-dose vaginal estrogen
What is the key factor in choosing an estrogen formulation for genital atrophy?
Patient preference
What is the primary indication for ospemifene?
Dyspareunia
What is the conclusion regarding the risk of breast cancer recurrence with the use of low-dose local estrogen?
There is no evidence that it increases the risk of breast cancer recurrence.
What is the contraindication for using ospemifene in women with a history of?
Breast cancer
Who is the chair of the Department of Obstetrics and Gynecology?
D. Ashley Hill
What is the name of the database used in the evidence-based search?
All of the above
What is the name of the journal that published the article by Johnson and Hauck in 2016?
American Family Physician
What is the name of the study that investigated the endometrial effects of a tissue-selective estrogen complex?
Pickar et al.
What is the name of the review that updates previous articles on this topic?
This review
What is the name of the institution that conducted the professional search?
Our institutional library team
What is the focus of the study by Goletiani et al?
Progesterone review for clinical studies
What is the title of the journal where Dr. Crider is an assistant professor?
Climacteric
What is the title of the article where Dr. Hill is mentioned as an author?
Management of menopausal symptoms
What is the title of the journal where Dr. Hill's correspondence address is mentioned?
Climacteric
What is the title of the study where omega-3 is mentioned as a treatment for vasomotor symptoms?
Efficacy of omega-3 for vasomotor symptoms treatment
What is the title of the journal where Dr. Loprinzi is an author?
Journal of National Comprehensive Cancer Network
What is the title of the article where Dr. Cohen is mentioned as an author?
Efficacy of omega-3 for vasomotor symptoms treatment
What is the title of the study where plant-based therapies are mentioned for menopausal symptoms?
Use of plant-based therapies and menopausal symptoms
What is the title of the journal where Dr. Kaunitz is an author?
Menopause
Study Notes
Hormone Therapy and Menopause
- Hormone therapy was previously prescribed to improve overall health and prevent cardiac disease, as well as for symptoms of menopause.
- Combined estrogen/progestogen therapy increases the risk of breast cancer when used for more than three to five years.
- Estrogen alone is not associated with an increased risk of breast cancer.
- In women with a uterus, combination therapy should only be used to treat menopausal symptoms like hot flashes and vaginal atrophy, using the smallest effective dosage for the shortest possible duration.
Nonhormonal Alternatives
- Low-dose paroxetine, venlafaxine, and gabapentin are effective alternatives to estrogen for treating hot flashes.
- Women with a uterus who are using estrogen should also take a progestogen to reduce the risk of endometrial cancer.
- A combined formulation of estrogen and the selective estrogen receptor modulator bazedoxifene may be beneficial for women who cannot tolerate progestogens.
Other Treatment Options
- There is no high-quality, consistent evidence that yoga, paced respiration, acupuncture, exercise, stress reduction, relaxation therapy, and alternative therapies are more effective than placebo.
- Soy products may provide modest improvement in hot flashes and vaginal dryness.
- Clinical hypnosis may significantly reduce hot flashes.
- Clonidine is somewhat more effective than placebo but has adverse effects like hypotension, dizziness, and rebound hypertension.
Genitourinary Syndrome of Menopause
- Genitourinary syndrome of menopause refers to bothersome genital symptoms from changes in the vulva, vagina, and lower genital tract caused by diminished estrogen.
- Up to one-half of women during menopause are affected by this condition.
- Low-dose vaginal estrogen is an effective treatment for mild vaginal dryness and related dyspareunia.
- Ospemifene is the only FDA-approved nonhormonal therapy for dyspareunia caused by menopausal atrophy.
Learn about hormone therapy and its effects on menopause, including the increased risk of breast cancer and treatment of menopausal symptoms.
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